Working as a moving and handling advisor, the link between maintaining a person’s pressure care and their moving and handling requirements, particularly bed care / maintaining a person’s care in bed is somewhat of a repeating theme in practice. This article will touch on the issue, and hopefully raise some points for consideration.
What do we mean by pressure care?
If someone is static for long periods of time, or only move a little over a long period of time, for example cannot shift their weight when sat in a chair or lying in a bed, the sustained pressure on that area can lead to skin damage (NHS 2017). Other elements such as heat, moisture and poor nutrition (NHS Improvement 2018) can exacerbate this, as well as how they’re moved, increasing the risk of a person developing pressure areas. Pressure care is the work we do to reduce the risk of a person developing pressure areas also recover from skin damage.
Caring for someone with or at risk of developing pressure areas
As professionals we aim to take a multidisciplinary & holistic approach, however the reality is that it is often not the case. Consider an individual whose mobility has deteriorated; nurses may put in a mattress overlay to reduce the risk of pressure damage. This then generates a referral to Occupational Therapy services, as the person is now struggling to transfer from the bed to the commode. This could be due to the extra height of the bed with the overlay, or the change in support of the mattress, hindering the person being able to push up from the bed to transfer. In this case, as we have not considered the persons interaction with the environment (Law Et al, 1996), we may have actually not solved the pressure care problem, at least in the long term, as they cannot get out of bed without support of two people whereas prior to the intervention the persons partner could assist therfore increasing the frequency the person could stand throughout the day, naturally reducing pressure on the highest risk areas. On one hand we may reduce the risk of the person developing pressures sores when lying in bed but on the other we may have created problems leading to further reduced mobility, dependence on outside care and create longer term pressure care issues due to potential further loss of mobility.
A team approach could have mitigated against this, by professionals liaising with each other and the person, they could have formulated a solution that is a better fit between the person and their environment, enabling the partner to continue to assist with daily commode transfers maybe by providing extra handling equipment, or providing the partner with advice on handling techniques along side using the overlay mattress.
When dealing with persons at risk of pressure damage, we truly need to be holistic and communicate as a multi-disciplinary team (SCIE 2018), as supposed to just say that we are or do. In the field of Moving and handling it is important to do just that, rather then just look at one issue in isolation, but the potential knock on effects, in this case an increased dependence on formal carers to visit. Considering the person is key, how they interact with the environment, how this effect their activities of daily living. Using a theoretical model of practice alongside standard risk assessments approaches as the Person, Environment, Occupation model (Law Et al) can help guide us in ensuring we are holistic in a person’s care (Maclean Et al 2012).
There have been significant advances in technology within pressure care over recent years. For example, hybrid mattresses which provide a medium level of pressure care, with the addition of an air compressor immediately upgrades the pressure relieving qualities of the mattress to a much higher level. Repositioning equipment which shifts a person’s weight in the bed automatically reducing the risk of pressure damage such as patient turning devices like Frontier Medical’s TOTO or Invacare’s SoftTilt reduce the need for carers to assist to reposition them as often as they might otherwise do in the absence of this technology. Advances in handling equipment; Ceiling track hoists, that enable people to be turned more easily via the fitting of a sheet that attaches, like RoMedic’s top sheet, in some cases reducing the need for a second carer, allowing a relative to turn a person and potentially more frequently. Better understanding around the causes of pressure damage and moving and handling training. Using simple handling techniques such as the use of slide sheets to reposition a person in bed, or positional wedges to enable one person, such as a relative, to safely reposition a person in bed.
Better understanding of pressure care by health professionals and equipment manufacturers is leading to improvements in patient care. Understanding the person as a whole, rather than as simply a person that needs pressure areas treated can help be more holistic, as can good team communication and proactivity on the part of statutory bodies and community teams.
The advent of more advanced pressure care management equipment and moving and handling equipment and training gives health professionals more options around care at home and the option of a reduced need for outside care intervention to provide support. Also reduce the need for large care packages or the number of carers required at each call in some cases, whilst still maintaining the quality of care for the patient.
Author – John Callas, Occupational Therapist, M&H expert, Associate of The OT Service